Shoulder Pain

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Shoulder Pain

Postby Toolish » Fri Apr 05, 2013 9:33 pm

Whenever I am on the bike for extended periods of time (anything from about 1 hour onwards) I get a sore right shoulder.

The pain is in the back, near the inside top of my shoulder blade. It is only on the right, never the left. Does not seem to matter if I ride in the drops, on the hoods or on the TT bike so not sure it is too position specific.

This has pretty much happened to me since I started riding 4-5 years ago. I just figured as I got more KM in it would get better over time...wrong!

I went to a physio who suggested some postural work but it does not seem to have helped for the couple of months I have been doing it.

I am actually a triathlete and I noticed that in races it never hurts. I did an ironman, spent 7 hours on the bike and nothing more than mild discomfort. From that I decided when the pain comes on to replicate swimming which seems to help. If I swing my arm forward the pain seems to move up my back and n goes away all together. 5 minutes of arm swinging seems to reset things for 40ish minutes then the pain comes back. Obviously swimming for 40 minutes prior to riding has the same effect but bigger.

It is actually the thing that limits my bike time more than my legs...and it is getting bloody frustrating.

Any suggestions welcome on what it might be, what to try, or even people I could go to see in either Melbourne or Adelaide.
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by BNA » Fri Apr 05, 2013 11:26 pm

BNA
 

Re: Shoulder Pain

Postby Tornado » Fri Apr 05, 2013 11:26 pm

I'm guessing you may be asked if it is a new bike for you. Possibly a bike fit issue? Like bar width vs shoulder width? Too much weight on your arms and one is feeling it more than the other. I'm no expert but thought I'd pop a couple of theorys.
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Re: Shoulder Pain

Postby winstonw » Sat Apr 06, 2013 5:21 am

very common for people who
- spend a lot of time with poor posture at computers, especially under stress that stimulates fight/flight muscle patterning.
- have poor rear shoulder and upper back muscle development due to lack of use of these
- have cervical vertebral disc irritation.
- people new to riding bicycles or using drop bars.

the pain may be reproduced with pressure to the levator scapulae or lower trapezius trigger points, but working these points for weeks usually yields unsatisfactory results.

my suggestion is
- better posture at all times as suggested by your physio.
- full range, very high rep upper limb pull and push exercises (inclined pull ups, seated row, push ups)
- shoulder and neck muscle exercises for releasing tension (high rep shoulder and neck exercises - shrugs and rolls with 2-5kg in each hand, poked chin double chin glides)
- thoracic and cervical spine mobilization from a manual therapist physio, in addition to self flexibility exercises for same.
- work and personal stress reduction techniques if required (meditation, conflict resolution, awareness and training of diaphragmatic breathing).

some people who have had neck trauma (whiplash or compression injuries) sometimes have thickened and tight connective tissue in their spinal joints in the upper thoracic and cervical spine. this may require more specific treatment from a manual therapist, in addition to full spine stretching.

settling the pain may take up to 4 weeks with all of this.
sometimes pain similar to what you describe is contributed to by an irritated cervical disc (often C4 or 5). if you have had neck trauma before, I'd suggest you seek out a manual therapy physio and tell them about it.

in summary, ime the pain is usually one or a combo of
- cervical disc, facet joint irritation, or nerve root irritation
- posterior shoulder girdle muscles put on sustained stretch, as when building time in the saddle too quickly without allowing adequate time for adaptation.
- poor strength and balance of shoulder girdle musculature.
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Re: Shoulder Pain

Postby Toolish » Sat Apr 06, 2013 10:32 am

Tornado wrote:I'm guessing you may be asked if it is a new bike for you. Possibly a bike fit issue? Like bar width vs shoulder width? Too much weight on your arms and one is feeling it more than the other. I'm no expert but thought I'd pop a couple of theorys.


Sorry. Forgot to mention in original post. Bought a new bike and had a bike fit.
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Re: Shoulder Pain

Postby Toolish » Sat Apr 06, 2013 10:39 am

winstonw wrote:very common for people who
- spend a lot of time with poor posture at computers, especially under stress that stimulates fight/flight muscle patterning.YEP, that is me
- have poor rear shoulder and upper back muscle development due to lack of use of theseYes to this one too.
- have cervical vertebral disc irritation.
- people new to riding bicycles or using drop bars.

the pain may be reproduced with pressure to the levator scapulae or lower trapezius trigger points, but working these points for weeks usually yields unsatisfactory results. Yeah, that sounds right. I tried chiro and a massage therapist. He could get a similar pain by pushing on the area about halfway up the inside of the shoulder blade or a fraction higher.

my suggestion is
- better posture at all times as suggested by your physio. I am trying, but it is really hard to improve posture consistently. I am getting better slowly.
- full range, very high rep upper limb pull and push exercises (inclined pull ups, seated row, push ups) Bent rows, upright rows, lat raises any good here too?
- shoulder and neck muscle exercises for releasing tension (high rep shoulder and neck exercises - shrugs and rolls with 2-5kg in each hand, poked chin double chin glides)What is a poked chin double chin glide
- thoracic and cervical spine mobilization from a manual therapist physio, in addition to self flexibility exercises for same. I have been using a foam roller daily working on thorasic spine flexibility. It has helped with the posture issues, not so much the bike pain issues.
- work and personal stress reduction techniques if required (meditation, conflict resolution, awareness and training of diaphragmatic breathing). Don't think this is an issue. Pretty stress free.

some people who have had neck trauma (whiplash or compression injuries) sometimes have thickened and tight connective tissue in their spinal joints in the upper thoracic and cervical spine. this may require more specific treatment from a manual therapist, in addition to full spine stretching.

settling the pain may take up to 4 weeks with all of this.
sometimes pain similar to what you describe is contributed to by an irritated cervical disc (often C4 or 5). if you have had neck trauma before, I'd suggest you seek out a manual therapy physio and tell them about it.

in summary, ime the pain is usually one or a combo of
- cervical disc, facet joint irritation, or nerve root irritation
- posterior shoulder girdle muscles put on sustained stretch, as when building time in the saddle too quickly without allowing adequate time for adaptation.
- poor strength and balance of shoulder girdle musculature.


Thanks so much for this post. Has put together a lot of different areas to work on. I will work out a program of rows, pulls, shrugs etc. Should I be looking at something like 3 sets or 20 reps 3 times a week for each exercise?

Also, I had thought of looking at pilates as a core strength thing. Thoughts?
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